What's the Best Diet to Prevent Heart Disease?

Leslie Cho, M.D.

As an interventional cardiologist who specializes in prevention, patients, friends and family ask me all the time which diet will best prevent heart disease.

There's been much hype and fanfare surrounding various diets, but the diet that has consistently shown benefit in randomized control studies is the Mediterranean diet. It's been shown to reduce heart attack and stroke as well as lowering LDL (bad) cholesterol. The Mediterranean diet is based on the traditional eating habits found in Southern Italy and Greece in the early 1960s. It's centered around plant-based foods -- heavy on vegetables, fruits, legumes, fish, olive oil and some amount of nuts. But what does that really mean, and how much of these should we be eating? We can all agree that even too much of good thing is bad. So here's some helpful advice about how to follow the Mediterranean diet as studied in trials:

-- Vegetables: 3 servings a day (1 serving = 1/2 cooked or 1 cup of raw vegetables)

-- Fruits: 3 servings a day (1 serving= 1/2 to 1 cup)

-- Olive oil: 1 tablespoon a day, but no more than 4 tablespoons a day. This includes your cooking oil.

-- Legumes: 3 servings a week (beans, peas, alfalfa, peanuts,etc.)

-- Fish: 3 servings a week. The smellier the fish are, the better, because they contain higher levels of omega-3 fatty acids. Smart choices include salmon, tuna, herring, sardines, mackerel and anchovies.

-- Nuts: 3 servings a week (1 serving = 1/4 cup, 1 oz. or 2 tablespoons of nut butter). Ideally, go for raw, unsalted and dry roasted walnuts, almonds or hazelnuts.

-- Starches: 3 to 6 servings a day (1 serving = 1/2 cooked, 1 slice of bread or 1 ounce of dry cereal). Choose whole grains, oats, barley, brown rice, quinoa and red skin or sweet potatoes.

-- White meat: 3 servings a week (1 serving = 3 oz.) Choose skinless poultry. Poultry includes choices such as chicken, turkey, pheasants and ostrich instead of red meat. You should have no more than 1 serving (3 oz.) of red meat a week. Choose lean cuts such as sirloin, tenderloin or flank steak if you have to have red meat.

-- Dairy/eggs: 3 servings a week. Choose 1 percent or fat-free milk, yogurt or cottage cheese. There are no limits on egg whites.

-- Desserts: 1 serving a week (1 serving =3 oz.) If possible, let fruit be your dessert. If you have to eat baked goods, choose one with healthy ingredients, and eat smaller portions.

-- Wine: 4-6 oz. a day. No beer or hard liquor; drinking wine is optional. Don't start drinking if you've never drank before. There is no good data that taking up alcohol will prevent heart disease.

The first thing people notice about this diet is the limit on fish, nuts, meat and dairy to only 3 servings a week -- not every day. Also, notice the lack of animal fat. In this diet, meat is an accent, not a centerpiece of your meal.

Finally, eating is one of the greatest pleasures in life. Enjoy your food, eat what's good for you in moderation and remember the words of Hippocrates: "Let food be thy medicine, and medicine be thy food."

Leslie Cho, MD, is Director of the Cleveland Clinic's Women's Cardiovascular Center. She is also Section Head, Preventive Cardiology and Rehabilitation in the Robert and Suzanne Tomsich Department of Cardiovascular Medicine at Cleveland Clinic. Dr. Cho is board-certified in interventional cardiology, cardiovascular medicine and internal medicine. Her specialty interests focus on general cardiology, heart disease and peripheral arterial and vascular disease, and their attendant therapies and treatments. Dr. Cho's clinical research interests are women and heart disease and the role of nutrition in hypercholesterolemia. Her research has garnered her many grants to study various therapeutic treatments for heart disease. In 1998, she received the American Heart Association's Women in Cardiology award. In 1999, the World Heart Federation named her Fellow of Cardiovascular Epidemiology and Prevention. She is author or co-author of numerous peer-reviewed articles and abstracts in leading medical journals, and she has authored medical textbooks and contributed chapters to medical textbooks related to her specialty interests. Dr. Cho is a fellow of the American College of Cardiology and serves on the Peripheral Disease Committee. She is a member of the American Board of Internal Medicine and the American Heart Association.